Sabrina Mitchell (3728866) UWC – South Africa’s Health Care System

Personal Reflection

“A hospital is no place to be sick.” – Samuel Goldwyn

Trauma and illness are an inevitable part of life and at some point, we will find ourselves needing to be hospitalized. Alas, for many South Africans, the idea of going to a hospital is less about being treated and more about the concern as to whether we will make it out alive…

The image that I captured shows a single bench with a graveyard in the background. The bench represents a bed for the patient. However, there is only one bench and there are only so many patients who can fit onto this bench. Government hospitals have an influx of patients due to much of the population being unable to afford medical aids. Many hospitals do not have enough beds to accommodate these patients and it is not uncommon to see patients standing or sitting on the dirty hospital floors. The bench also represents a feeling of being alone as there is nobody surrounding the bench. Often a patient waits so long to be treated because of a shortage of staff that they feel somewhat invisible. Visiting hours are also extremely strict so patients often don’t see their family members as they are working or cannot make it on time.

The other part of my image is the graveyard. This represents an uneasy atmosphere of impending death. Patients fear the idea of dying because as a developing country, government hospitals do not receive adequate funding in order to maintain their facilities. This is problematic because ill-maintained hospitals often carry diseases. Thus, patients fear being admitted for one illness and deteriorating further due to nosocomial infection. The graveyard also represents the fear the government hospitals instill in patients due to negligence in terms of care and treatment. They are not always handled with respect and may not receive the necessary treatment or therapy needed due to a lack of services. As mentioned previously, government hospitals lack funding and therefore cannot afford to offer all the services that would be available in private institutions. One health care professional may have to take on responsibilities that are beyond their expertise; patients are then at risk of receiving inappropriate or incorrect treatment as they are not fortunate enough to see a specialist, or they are just not seen to as it is difficult for the staff members to balance the rush of incoming patients.

So how do patients experience physiotherapy in government hospitals? These services are available in many of the bigger hospitals; however, the majority of the population live in rural areas which creates a problem for those who require therapy more often. Patients may have brief access to a physiotherapist whilst hospitalized but thereafter may not be able to return. This may lead to patients re-injuring themselves or just struggling to return to their daily activities because they have not had enough education on how to cope with their ailment. Other patients may be uninterested or unwilling to partake in physiotherapy as they are more concerned about other factors. They may feel scared and alone in their situation, or they may be worried about their family back home. These patients generally want to be left alone and to be released as soon as possible. They do not always consider the benefits of the service and think only about addressing the problem at that specific moment in time.

Academic Literature

The remainder of this essay will make use of literature which will support the aforementioned factors of the problems with the health care system in South Africa.

A major issue in South Africa is that of poverty. The majority of the population are unemployed or barely survive off the minimum wage; thus, medical aid is a luxury that most citizens aren’t familiar with. In a nationally representative survey, it was found that 70% of the population make use of government health care services, whilst the remainder utilize private health care services or traditional health care practitioners (Rehle et al., 2005). This creates a burden for the public health sector as there is a lack of funding and a shortage of health care staff.

The lack of personnel within the health care system and more specifically, within rural areas, is problematic as the system cannot function effectively without them. The question is- why are more practitioners moving towards the private sector? Couper and Kotzee (2006) conducted interviews with a select number of qualified doctors who work in rural hospitals in the Limpopo province of South Africa. Key factors which resulted in practitioners moving away from the public sector was insufficient salaries, heavy work loads and lack of specialist support, lack of medical equipment and appropriate facilities, lack of staff, inadequate hospital management and poor housing. These factors indirectly play a role in patient care because the employees are miserable in their environment and don’t have the resources to care for patients properly.

A cause for concern in patients admitted to government hospitals in South Africa is the spread of nosocomial infections. Patients are hospitalized after sustaining a fracture, for example, and end up deteriorating due to a hospital acquired infection. A study conducted by Du Plessis and Monkoe (2010) focused on the underlying causes of nosocomial infections. Non-compliance with hand-hygiene was found to be a major issue; thus, increasing the risk of spreading pathogens from the contaminated hands of the health care members to patients. The researchers observed that the employees tended to re-contaminate their clean hands by touching objects in between patient care. Another observation was that after contact with the patient, the health care staff tended to touch parts of their face before washing their hands; therefore increasing the chance of spreading an infection from the patient to themselves.

The last challenge that will be discussed is that of rehabilitation in South Africa. In hospitals, patients are treated for their immediate impairment and sent home in order to accommodate other patients. Many of these patients live in rural areas that are far from hospitals and cannot attend rehabilitation due to the distance and lack of transport. This results in the inadequate integration of patients back into their community. Swartz and Visagie (2016) did a case study on this particular problem and found that the participant’s disabilities were much worse than expected when compared to their impairments. Early intervention and retraining of function were not provided, and environmental barriers caused additional barriers.

References

Du Plessis, J., & Monkoe, N. (2010). Hospital Acquired Infections in Intensive Care Units (ICUs). Medical Technology SA, 24(2), 9-14. Retrieved from https://www.mtsaj.co.za/index.php/mtsaj/article/view/7/6

Kotzee, T., & Couper, I. (2006). What interventions do South African qualified doctors think will retain them in rural hospitals of the Limpopo province of South Africa?. Rural And Remote Health, 6(3), 581. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/16965219

Rehle, T., Shisana, O., Simbayi, L., Parker, W., Zuma, K., & Bhana, A. et al. (2005). South African national HIV prevalence, HIV incidence, behaviour and communication survey. SAHARA-J: Journal Of Social Aspects Of HIV/AIDS, 2(3), 304-310. doi: 10.1080/17290376.2005.9724855

Visagie, S., & Swartz, L. (2016). Rural South Africans’ rehabilitation experiences: Case studies from the Northern Cape Province. South African Journal Of Physiotherapy, 72(1), 1-8. doi: 10.4102/sajp.v72i1.298